SARS-Coronavirus-2 and acute urticaria
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A 51-year-old otherwise healthy woman presented with a 3-day history of dry cough and arthralgias. Simultaneously, she developed widespread pruritic evanescent skin lesions (lasting less than 24 hours). Physical examination revealed multiple well-demarcated erythematous edematous papules and plaques located on the trunk, thighs, upper limbs, and predominantly on the facial area and dorsal aspects of bilateral hands. Chest radiography revealed bilateral pulmonary infiltrates. SARS-Coronavirus-2 (SARS-CoV-2) PCR was positive on nasopharyngeal swab, confirming the diagnosis of SARS-CoV-2 infection (COVID-19).

The patient was admitted to the hospital with the diagnosis of bilateral pneumonia and acute urticaria in the context of COVID-19. Treatment with loratadine 10 mg every 12 hours was initiated, with early improvement of pruritus and resolution of skin lesions within 2 days. The patient did not experience recurrent episodes of urticaria after 1 week of antihistaminic treatment.

Since its appearance in December 2019, SARS-CoV-2 infections have been growing exponentially, up to becoming a global health concern. Although this is a viral infection that affects mainly the respiratory tract, various skin manifestations have been notified in this context. Recalcati conducted a retrospective analysis concluding that up to 20% of patients infected by SARS-CoV-2 developed cutaneous manifestations of the disease as erythematous rash, urticarial lesions, and chickenpox-like vesicles. Other skin manifestations have been described in SARS-CoV-2 infection, such as livedo reticularis or Dengue-like rash.

The association between urticaria and infectious diseases has been discussed for more than 100 years. However, this association with virus infections has rarely been reported in the literature. The lack of reported cases is probably because of the difficulty in establishing a cause and effect relationship.